Osteoporosis causes

Because secondary osteoporosis causes play a significant role in men, any secondary cause (e.g., hypogonadism) should be excluded or treated before considering other drug therapy. 

National Institute of Arthritis and Musculoskeletal and Skin Diseases. 1986. Osteoporosis. Cause, treatment, prevention. NIH Pub. No. 86-2226. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. 

Glucocorticoid treatment for arthritis or other ailments can very quickly produce a form of osteoporosis caused by the inhibition of bone formation [334]. In such cases, the decrease in bone mass may be as much as 10-20%, but examination of trabecular bone reveals a much greater (30-40%) decrease in this component of bone [335]. Combination therapies with vitamin D and bisphosphonates, calcitonin or fluoride can be effective [336]. Therapy employing vitamin D or 1,25-(OH)2D3, the latter being highly calcaemic, should also include serum calcium monitoring and the use of thiazide diuretics as appropriate. 

The drug of choice for the management of osteoporosis caused by high-dose use of glucocorticoids is... 

Osteoporosis causes 1.5 million fractures annually, including hip and spine fractures that increase both morbidity and mortality. In women older than 50 years, one in six will experience a hip fracture, and oniy 40% of patients older than 55 years with a hip fracture actually recover their mobility (116). (A comprehensive review of pharmacological therapies available for the treatment and prevention of osteoporosis can be found in Chapter 35.)... 

Unfortunately steroids merely suppress the inflammation while the underlying cause of the disease remains. Another serious concern about steroids is that of toxicity. The abmpt withdrawal of glucocorticoid steroids results in acute adrenal insufficiency. Long term use may induce osteoporosis, peptidic ulcers, the retention of fluid, or an increased susceptibiUty to infections. Because of these problems, steroids are rarely the first line of treatment for any inflammatory condition, and their use in rheumatoid arthritis begins after more conservative therapies have failed. 

RIGGS B L, KHOSLA s and MELTON L J, 111 (1998) A Unitary model for involutional osteoporosis estrogen deficiency causes both type 1 and type 11 osteoporosis in postmenopausal women and contributes to bone loss in aging men. J Bone Min Res 13, 16 i-l i. 

Osteoporosis can be classified as either primary (no known cause) or secondary (caused by drugs or other diseases). Primary osteoporosis is found most often in postmenopausal women and aging men, but it can occur in other age groups as well. 

Osteoporosis also can develop from secondary causes such as concurrent disease states and drugs (Table 53-2). 

Approximately one-third to one-half of osteoporosis cases in men and half of all cases in perimenopausal women are due to secondary causes.4 Common secondary causes in men include hypogonadism, glucocorticoid use, and alcoholism. The most common cause of drug-induced osteoporosis is glucocorticoid use. 

Only useful to rule out secondary causes of osteoporosis Diagnostic Tests... 

Assess patient risk factors for osteoporosis, with special attention to age, menopausal status, previous history of osteoporotic fracture, smoking status, low body weight, family history of osteoporotic fracture in first-degree relatives, and presence of secondary causes of osteoporosis. 

RA reduces a patient s average life expectancy by 3 to 10 years, but RA alone rarely causes death.11,12 Instead, specific comorbidities contribute to premature death independent of safety issues surrounding the use of immunomodula-ting medications. O The comorbidities with the greatest impact on morbidity and mortality associated with RA are (1) cardiovascular disease, (2) infections, (3) malignancy, and (4) osteoporosis.11,12... 

In leukemia, the intensified use of methotrexate and glucocorticoids is responsible for causing an increased frequency of neurotoxicity and, in older children and adults, avascular necrosis of bone. High cumulative doses of anthracyclines can cause cardiomyopathy. Cranial irradiation causes neuropsychologic deficits and endocrine abnormalities that lead to obesity, short stature, precocious puberty, and osteoporosis.3 As newer and more intensive treatments enter clinical trials, close observation for long-term side effects will assume even greater importance.24... 

Selenium, which at present does not appear to be essential to man, apparently can be either beneficial or harmful to man, depending on very small differences in the concentrations. 13 Molybdenum can also be a boon or a detriment to health. It helps stabilize enamel and prevent caries in teeth, but also causes osteoporosis, a weakening of the bones.13... 

Bruising, local irritation, mild pain, erythema, histamine-like reactions, and hematoma can occur at the site of injection. Hypersensitivity reactions involving chills, fever, urticaria, and rarely bronchospasm, nausea, vomiting, and shock have been reported in patients with HIT. Long-term UFH has been reported to cause alopecia, priapism, hyperkalemia, and osteoporosis. 

The well-appreciated adverse effects of glucocorticoids include hyperglycemia, hypertension, osteoporosis, fluid retention and electrolyte disturbances, myopathies, psychosis, and reduced resistance to infection. In addition, glucocorticoid use may cause adrenocortical suppression. Specific regimens for withdrawal of glucocorticoid therapy have been suggested. 

Osteoporosis is a consequence of the reduction of skeletal mass caused by an imbalance between bone resorption and bone formation. The loss of gonadal function and aging are the two main factors that contribute to the development of osteoporosis. Around the fourth or fifth decade of life, men and women lose bone at a rate of 0.3-0.5% per year. After menopause, the rate of bone loss increases to 10% a year (Nordin et al. 1990 Riggs et al. 1986,1998). The bone loss due to estrogen withdrawal is associated with increments in both bone resorption as well as in bone formation, with the former exceeding the latter. This indicates the birth of new BMUs or an increase in the lifespan of cur-... 

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